Evidence map›Paper›PMID 18670667›Full record

ArticleBulletin of the World Health Organization2008

Schizophrenia treatment in the developing world: an interregional and multinational cost-effectiveness analysis.

Dan Chisholm, Oye Gureje, Sandra Saldivia, Marcelo Villalón Calderón, Rajitha Wickremasinghe, Nalaka Mendis, Jose-Luis Ayuso-Mateos, Shekhar Saxena

Open access · diamondAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Bulletin of the World Health Organization, 2008. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 43 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
43citing papers in PubMed, 6 pooled it
22.6field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

43 citing papers in PubMed, 6 syntheses or guidelines pooled it, 95 citations in OpenAlex.

  1. Pooled it
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  4. Sulpiride versus placebo for schizophrenia.The Cochrane database of systematic reviews · 2014
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  19. Socio-economic factors associated with mental health disorders in Fort Portal, western Uganda.The South African journal of psychiatry : SAJP : the journal of the Society of Psychiatrists of South Africa · 2020
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 1 institution in 2 countries.

Dan ChisholmDepartment of Health Systems Financing, World Health Organization, Geneva, Switzerland. ChisholmD@who.int
Oye Gureje
Sandra Saldivia
Marcelo Villalón Calderón
Rajitha Wickremasinghe
Nalaka Mendis
Jose-Luis Ayuso-Mateos
Shekhar Saxena
World Health Organization - Pakistan · PK

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveSchizophrenia is a highly disabling disease and is costly to treat. We set out to establish what are the most cost-effective interventions applicable to developing regions and countries.

methodsAnalysis was undertaken at the level of three WHO subregions spanning the Americas, Africa and South-East Asia, and subsequently in three member states (Chile, Nigeria and Sri Lanka). A state transition model was used to estimate the population-level health impact of older and newer antipsychotic drugs, alone or in combination with psychosocial intervention. Total population-level costs (in international dollars or local currencies) and effectiveness (measured in disability-adjusted life years averted) were combined to form cost-effectiveness ratios.

findingsThe most cost-effective interventions were those using older antipsychotic drugs combined with psychosocial treatment, delivered via a community-based service model (I$ 2350-7158 per disability-adjusted life year averted across the three subregions, I$ 1670-3400 following country-level contextualisation within each of these subregions). The relative cost-effectiveness of interventions making use of newer, "atypical" antipsychotic drugs is estimated to be much less favourable.

conclusionBy moving to a community-based service model and selecting efficient treatment options, the cost of substantially increasing treatment coverage is not high (less than I$ 1 investment per capita). Taken together with other priority-setting criteria such as disease severity, vulnerability and human rights protection, this study suggests that a great deal more could be done for persons and families living under the spectre of this disorder.

Indexed as

Developing CountriesAfrica, WesternAntipsychotic AgentsAsia, SoutheasternCommunity Mental Health ServicesCost-Benefit AnalysisHealth Care CostsHumansModels, EconometricModels, OrganizationalPersons with Psychiatric DisordersPsychotherapyPublic Health InformaticsQuality-Adjusted Life YearsSchizophreniaSouth AmericaAntipsychotic Agents

Identifiers

PMID18670667
PMCPMC2647485
OpenAlexW2141477723

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.